HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � � 7• ) 7 � Permit Number:,,
RECL- I
Building Permit Application
Planning and Development Services JUL Z 70W
Building and Code Regulation Division.
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMIT APPLICATION FOR:
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Address: (�,� mu �r��1 ���CD�i �2;Z ( - D I I'"S
Legal Description: -
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Property Tax ID #:? ,2l® (�) -4)0 (I - C�YY)� (� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Haamonai wom to oe perrormea unaer tnis permit- cnecK an mai apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors..
.Electric _ Plumbing _ Sprinklers_ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ( 9560 - 60 Utilities: _ Sewer _ Septic Building Height:
Name
;Address: �
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City: ate:
Zip Code: !44- q K2 Fax:
Phone No. '7:79- 577-f3�C^27
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: JLdn3ard )Lk.s'l.O--
Company:4—:�A: (: 2 C �C-
Address: (o�2D4 6(4'e' G_`Ao / AJ'_Q--
City: *- Fr"P�l GStater _
Zip Code: 5 ,� 8Fax:`77,2 46-7- 135`7
Phone No _ -7 7 2 IL iSq - '221 q &o
E -Mail 61
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State or County License -;�C CSO 15Q:-`(
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced,;prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws'or and covenants -that may restrict or prohibit such
structure. Please consult with your Home "Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I Will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes.and St; Lucie County Amendments.
The following building permit applications are exempt from undergoing a"full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice'for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of gGvlper/ Agent/ Lessee/Contractor
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Signature of Contractor/Lice a Ides:.`
STATE OF FLORI
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STATE OF FLORID
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COUNTY OF
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COUNTY OF
The forgoing instru a was "acknowledged befor
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The forgoing instrument was acknowledged before me
this9M day of. 26 by
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this 25%y of '` 20il by,
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DATE
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(N a of person acknowledging)
(Name of "person ackn w dging )" =
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(Signature ofo ary Public- State of Florida)
Signature of otary Public- State of Florida )
✓
DATE
Personally Known OR Produced Identification
Personally Known
Type of Identification
Type of identification STACEYGARC
Produced
COMPLETED
Produced - MYCOMMISSION#Gi
o.• EXPIRES: May 16,
w.$odi�Q:�j Th NotaryPubficl
Commission No. (Seal),
Commission No.
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REVIEWS
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SUPERVISOR"
PLANS ..
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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